The Abilene reflector. [volume] (Abilene, Kan.) 1883-1888, 1887-03-03
CIIRE OF HAREIIP
Medical Science rs Applied to Remedyina
This Cn,ightly Malformation.

to require any extended notice Is to the
appearances presented. However, as
the operation for its relief is frequently
done in slip-shod. imperfect manner,
it may not be amiss TO give a brief
notice of this affection. 1t is due to an
arrest of development, and consists Of
one or two assures through the upper
lip, frequently extending through the
rim of bone in which the upper teeth
are implanted, and this may reach
backward through both the hard and
soft palate. When it is single the
cleft is located TO one side, so that the
gap extends into one nostril. leaving
one side of the upper lip wider than the
other. Single harelip may not involve
the bOny parts, or there may be an eX-
tensiye deficiency in the palate. 1t is
more frequently upon the left than
right side. In double harelip the bones
are included, and the deficiency may be
so great that the lips seem never to
have been formed. and the little piece
OF bone between the two clefts may be
displaced and appear attached to the
tip of the nose. No one knows any
reason why this arrest of development
should occur. but the cases are not 1T
! all infrequent in which other members
OF the same family are afflicted in the
| same way: hence there is some reason
for believing. in these instances, at
least. that hereditary influences have
been in action.
| There is some difference of opinion
a to the time an operation for the re-
lief of the deformity should be attempted.
1t seems that it should be done before
the teeth make their appearance. When
! the child is about four months old is
very good time for its performance. If
there be 4 projection of the intermediate
| piece of bone, it should be done much
earlier, as the bones of the jaws are
softer and more yielding. and the pres
sure of the lip thus formed has tend
ency to lessen the deformity of the roof
of the mouth the more the earlier it is
done The third or fourth week of life
is an appropriate time for the operation
in such cases. If it has been put of
until the teeth begin to appear, it should
be deferred until the last OF the third
year, Is while the process of tecthing
is in progress children are prone to
commissions and other nervous distur-
Dances from moderate irritations.
The operation itself is sufficiently
simple. The child is pat into broad
banda@e so that the limbs are all con-
fined, then giving ether or chl0rOfOrm,
placed upon Il table or in the arms OF
an assistant. and kept upon its back.
\ thread is then passed through the lip.
close to its red margin, to one side of
the tissure, and made into Il loop about
six inches long. another like it is in
serted on the other side; these enable
traction to be made, to secure proper
position. The edges of the assure are
then pared or ''freshened, after the
lip has been freed from attachments on
the under side which might interfere
with drawing the parts easily into Il
natural position. If there is bleeding
of any amount, it is easily arrested by
pressure of the fingers. The freshened
surfaces are brought together and held
there by pin passed deeply through,
transverscly, about midway between
the nose and edge of the lip. This is
secured by turns of darning cotton,
passed alternately over the ends Of the
pin which project, forming figure OF
s." Care must be taken when the |
two portions of lip are thus drawn to- |
gcther to have them ut the same level !
otherwise there will be an ugly appear
ance of the two parts of the lip not being |
of the same length.
A second pin should be passed through |
from side to side, secured in the same |
way. just at the junction of the Skin /
with the yermllion edge of the lip. A |
fine silk stitch should be put in close tc
the nose. cilectually closing the upper !
end OF the tissure, and another at the
lower extremity thereof; otherwise |
there will be an unsightly notch left at /
the edge of the lip. which second
operation may be required to close. The
silk stitches are often omitted, which |
accounts for some imperfect results.
The pins and stitches may be taken out
on the fourth or fifth day. Then Il strip
of adhesive plaster, narrow along the
lip, broader ut the ends, extending
across from one check to the other,
should be applied. and renewed as ii
becomes lOoSened for two or three weeks.
Until the pins and stitches are removed,
no plaster should be used. rs it causes
irritation, prevents con-
slant inspection. and interferes with
perfect cleanliness. Afterwards it is
In ordinary double harelip one of the
assures may be closed first, ami after 1t
has firmly united the same process may
he applied to the second. Sometimes
the portions removed to allow the union
of the edges of the tissure are preserved
still attached at their lower ends, and
then trimmed to a proper length and
stitched into place to effectively close
the notch at the lower end of the cleft
in the lip. If this projects too far after
healing is perfect it may be pared down
to proper dimensions 1t may be nee,
essary to relieve undue tension of the1
parts on, each side of the assure, which
would interfere with healing by incis-
ous made OutwarslS into the checks
from the junction Of the lip with the
nose.